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Immune reconstitution inflammatory syndrome from Penicillium marneffei in an HIV-infected child: a case report and review of literature.

Abstract

BACKGROUNDS
Disseminated Penicillium marneffei infection is one of the most common HIV-related opportunistic infections in Southeast Asia. Immune reconstitution inflammatory syndrome (IRIS) is a complication related to antiretroviral therapy (ART)-induced immune restoration. The aim of this report is to present a case of HIV-infected child who developed an unmasking type of IRIS caused by disseminated P. marneffei infection after ART initiation.
CASE PRESENTATION
A 14-year-old Thai HIV-infected girl presented with high-grade fever, multiple painful ulcerated oral lesions, generalized non-pruritic erythrematous skin papules and nodules with central umbilication, and multiple swollen, warm, and tender joints 8 weeks after ART initiation. At that time, her CD4+ cell count was 7.2% or 39 cells/mm3. On admission, her repeated CD4+ cell count was 11% or 51 cells/mm3 and her plasma HIV-RNA level was < 50 copies/mL. Her skin biopsy showed necrotizing histiocytic granuloma formation with neutrophilic infiltration in the upper and reticular dermis. Tissue sections stained with hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and Grocott methenamine silver (GMS) stain revealed numerous intracellular and extracellular, round to oval, elongated, thin-walled yeast cells with central septation. The hemoculture, bone marrow culture, and skin culture revealed no growth of fungus or bacteria. Our patient responded well to intravenous amphotericin B followed by oral itraconazole. She fully recovered after 4-month antifungal treatment without evidence of recurrence of disease.
CONCLUSIONS
IRIS from P. marneffei in HIV-infected people is rare. Appropriate recognition and properly treatment is important for a good prognosis.

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  • Authors

    Sudjaritruk T, Sirisanthana T, Sirisanthana V

    Institution

    Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, 50200 Chiang Mai, Thailand.

    Source

    BMC infectious diseases 12: 2012 pg 28

    MeSH

    Adolescent
    Anti-HIV Agents
    Asia, Southeastern
    Dermatomycoses
    Female
    HIV Infections
    Hand
    Histocytochemistry
    Humans
    Immune Reconstitution Inflammatory Syndrome
    Leg
    Microscopy
    Mycoses
    Osteomyelitis
    Penicillium

    Pub Type(s)

    Case Reports
    Journal Article
    Research Support, Non-U.S. Gov't
    Review

    Language

    eng

    PubMed ID

    22289885